Patients with Fibrotic ILD Commonly Experience Loss of Workplace Productivity, Study Finds

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by Santiago Gisler |

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Loss of productivity in the workplace is common among patients with fibrotic interstitial lung disease (ILD), and is associated with symptom severity and higher costs, according to data from a Canadian registry study.

The study, “Costs of Workplace Productivity Loss in Patients with Fibrotic Interstitial Lung Disease,” was published in the journal Chest.

More than 90% of patients with fibrotic ILD — a large group of lung diseases, the most common of which is idiopathic pulmonary fibrosis (IPF) — experience dyspnea (shortness of breath), and 85% of them experience coughing. Together with other common ILD-related conditions, including depression, these symptoms can cause functional impairment and lower quality of life.

Since ILD, and especially IPF incidence, increase with age and affect individuals who are of working age, the diseases may have a noticeable impact on workplace productivity.

To further investigate this potential link, researchers in Canada used prospective registry data and questionnaires to evaluate workplace productivity loss in patients with fibrotic ILD, and assess associated predictors and costs.

They analyzed data from six centers in the Canadian Registry for Pulmonary Fibrosis (CARE-PF), a registry intended to study the clinical history of fibrotic ILD.

The registry included patients with diagnosed IPF (45% in the study), chronic hypersensitivity pneumonitis (13%), idiopathic fibrotic nonspecific interstitial pneumonia (2%), and unclassified ILD (40%).

To assess health-related workplace productivity, patients filled out the Work Productivity and Activity Impairment (WPAI) questionnaire, containing six questions related to the impact of health on work and daily activities. Researchers also assessed additional factors, including demographics, smoking history, dyspnea score, cough severity, and lung function.

Data showed that out of the 650 enrolled patients (mean age of 68.6 years), 148 (23%) were employed. This employed subgroup was, on average, younger (mean of 61.4 versus 70.7 years), smoked less, had better lung function, and was more likely to receive ILD therapy than the unemployed subpopulation.

Compared with an age- and sex-matched Canadian population, the rate of employment of ILD patients between 25 and 54 years of age was 23% lower (83% versus 60%, respectively). In contrast, ILD patients 55 years or older had an 18% lower employment rate than the age- and sex-matched population (38% versus 20%, respectively).

Results showed that 55% of the employed patients reported a loss of productivity in the workplace. Among them, 14% reported a health-related inability to attend work (absenteeism; mean productivity loss of 2.3 hours per week), and 52% reported health-related impaired functionality at work (presenteeism; mean productivity loss of 5.5 hours per week).

Results also showed a high correlation between health effects on workplace productivity and its effects on daily activities. The impact of health on daily activities was significantly higher in unemployed patients.

Overall, regarding costs, the researchers found that the estimated annual cost of productivity loss among employed patients was 11,610 Canadian dollars (about 8,611 U.S. dollars) per employee with ILD. Of this amount, CA$3,377  ($2,505) was due to absenteeism, and CA$8,233 ($6,106) was due to presenteeism.

When analyzing which factors contributed to the loss of productivity among employed ILD patients, the team found that dyspnea and cough were independent predictors of productivity loss in the workplace. More specifically, the probability of workplace-related productivity loss increased by 4% for every point-increase in dyspnea, and 3% for every estimated 1 millimeter increase in cough severity.

The researchers found no significant cost differences between employed male and female patients, or between IPF and non-IPF patients. However, they did observe an increased estimated annual cost related to productivity loss among supplemental oxygen users compared with non-users (CA$24,768 versus CA$9,796, or about $18,370 versus $7,266 USD, respectively).

Overall, the team concluded that “workplace productivity loss is present in 55% of employed patients, and that a substantial percentage of additional patients are unemployed due to their ILD. We also show that productivity loss is strongly associated with dyspnea and cough severity and has significant costs.”

They further noted that “the strong association of workplace productivity loss with common ILD symptoms suggest the potential to impact workplace productivity with improved symptom management strategies or optimization of the workplace environment for patients with ILD who have significant dyspnea or cough.”

Given the consistency of the data found across the included centers in the study, the team believes the findings could extend to other developed countries.